For patients, why choose private clinic vs. large hospital?

[nychila]

I'm not currently living in the US, so I'm not very familiar with the health system. What I am very curious about is: What factors determine whether a patient chooses a private clinic or a large hospital when the patient wants to go for a specialized consultation or get a procedure done?

Why would a patient choose to go to a top hospital that does extensive research, or a large community hospital, vs. a private clinic? Do patients get faster care at private clinics? Better care at large hospitals? More luxurious environments at private clinics? Do both support various forms of insurance? Etc., etc. What exactly are the differences between a private clinic and a non-profit hospital FOR PATIENTS?

Any comments are greatly appreciated. The online articles that I have found haven't really helped me answer this question.

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[cookiemonsters]

I have been at both as a patient... in general, small private hospitals are good for 99% of things you will ever need as a patient. The wait time to see a doctor is usually a lot less too, and I sorta like the quieter environment a little more.

Academic hospitals look more like businesses than hospitals. Wait times to see a doctor can be excessive (I had to wait 3 months to see a urologist a few months ago). Most people go to these hospitals for peace of mind with their treatments, thinking the doctors must be better there. And obv if a person needs a cutting-edge procedure, they have to choose a hospitals that has doctor who know how to do it. EG my mother needed a certain surgery on her trachea and only 2 doctors in my city (both at the medical school) knew how to do it.

 

[theseeker4]

I'm not currently living in the US, so I'm not very familiar with the health system. What I am very curious about is: What factors determine whether a patient chooses a private clinic or a large hospital when the patient wants to go for a specialized consultation or get a procedure done?

Why would a patient choose to go to a top hospital that does extensive research, or a large community hospital, vs. a private clinic? Do patients get faster care at private clinics? Better care at large hospitals? More luxurious environments at private clinics? Do both support various forms of insurance? Etc., etc. What exactly are the differences between a private clinic and a non-profit hospital FOR PATIENTS?

Any comments are greatly appreciated. The online articles that I have found haven't really helped me answer this question.

Convenience is a large part of it. If you live outside of an urban center itself, it can seem like a huge deal to drive into the city (if the patient is even driving) to get to the large academic center. Living in suburban Detroit, a good portion of patients visibly shut down when the PCP I was shadowing mentioned going to one of the hospitals in the city (only a 20 minute drive from the PCP's office) for either a surgery or to consult with a specialist. As already mentioned, smaller clinics can have shorter wait times and a more personal feel. A large factor is also, who their primary doctor refers them to. For many patients, they will go to see who their PCP recommends without even considering the option of researching other specialists/centers and asking to be referred to one of those.

 

[LizzyM]

For many Americans, the first question is, "Is this doctor on my health plan?" Many Americans now have "preferred provider" insurance policies. In exchange for the referral of large number of patients from a specific insurance company, a physician agrees to accept a lower than usual fee. The physicians on the health plan are called "in network". If a patient chooses a physician who is "out of network" they pay a larger proportion of the bill and the bill itself may be higher.

For those with Medicaid, the government health care coverage for the poor, the question of "do they take Medicaid" is a big issue. The same goes for the uninsured who do not qualify for Medicaid (undocumented, for example). They often choose public hospitals and health clinics operated by charities specifically for the care of the poor. (Some but not all of these facilities operate with volunteer service providers.)

Convenience and safety are other factors that play into decisions about facilities. Many academic medical centers are located in urban areas, some are in areas that suburban folks consider downright dangerous. Given a choice between a safe, local neighborhood facility and one in a unfamiliar area that is difficult to navigate, many folks will choose the local community hospital or doctor's office rather than the tertiary center.

As mentioned previously, the long waits for appointments is another factor that drives some people toward their local community provider rather than a big academic medical center.

 

[nychila]

Thank you for all your replies. I just wanted to clarify a bit further:

Do most upper-middle class patients with good private employer insurance plans (employees of IBM and Boeing) tend to go to private clinics for family doctor visits, specialist consultations, and common surgical procedures?

A patient living in New York decides to undergo a hip replacement in a large hospital, are there any reasons that he would NOT want to choose a top orthopedic hospital such as Hospital for Special Surgery to go to a community hospital like Beth Israel instead, aside from physical distance and whether the provide accepts his insurance? Or is there practically no difference between the two hospitals in the patient’s perspective, unless it is a very complicated procedure that requires the best of the best surgeons?

After reading some articles, I found out that lots of times, the hospital or clinic charges excessively for a consultation or procedure, but then either the patient’s insurer or the patient himself negotiates the medical bill down to a more reasonable amount. As a result, hospitals and clinics are very often not paid in the full amount that it charges and its final bill for the same procedures often vary between different patients – why does this happen?

 

[LizzyM]

NYC is a special case because it has so many hospitals in such close proximity. Still, if someone I knew in NYC needed surgery, it is likely that their primary care provider or their rheumatologist would recommend a specific orthopedic surgeon or a few different ones. The patient might also ask around among family and friends to get some advice about others' experience with that specific surgical procedure and then check with insurance to see if a highly recommended physician is "in network".

The hospital the physician is affiliated with is less of an issue than does the physician come highly recommended (generally associated with high volume for a specific procedure) and is it "in network".

Yes, insurance companies routinely pay a negotiated amount that is less than the "charge" for the procedure. Different insurance companies may negotiate different payment schemes. Medicare (for the elderly and patients in chronic kidney failure) and Medicaid (for the poor and disabled) are notorious for paying much less than the "list price".

If you are interested in how messed up payment for services is, read The Cost of Hope by Amanda Bennett, particularly the last chapter or two that gets into the cost of specific services (CT scans in particular) in different parts of the US for a person with cancer.

One more thing... some top doctors at the top specialty hospitals are booked solid and take patients only with a referral and with a preference for particularly difficult or challenging cases. So even if you wanted to get in to see Dr. Superstar, it might not be possible if you are an otherwise healthy person in need of a very routine procedure.

 

[nysegop]

I usually go to the hospital affiliated with my local medical school. Why? Because it's close. I have nothing against smaller clinics, they're just not very close to me.

 

[Danbo1957]

In the US financial and insurance requirements determine access to medical care for most.

The rule that I follow: go to a local private multi-specialty clinic where you can form long-term relationships with doctors, nurses, and staff; go to a community general hospital for surgery and any required inpatient care; go to an academic hospital only if absolutely required (where you will be treated as a subject not as a patient).